Provider Demographics
NPI:1376097832
Name:EARLY, KRISTA (PHN)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:EARLY
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2473
Mailing Address - Country:US
Mailing Address - Phone:651-385-6141
Mailing Address - Fax:651-267-4882
Practice Address - Street 1:426 WEST AVE
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2473
Practice Address - Country:US
Practice Address - Phone:651-385-6141
Practice Address - Fax:651-267-4882
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR131937-6163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA188959100OtherUMPI